{include file="public/header"/}
{include file="public/navleft"}

<div class="tpl-content-wrapper">
    <div class="tpl-content-page-title">
        确认删除 表单
    </div>
    <ol class="am-breadcrumb">
        <li><a href="#" class="am-icon-home">首页</a></li>
        <li><a href="#">表单</a></li>
        <li class="am-active">医院详情 表单</li>
    </ol>
    <div class="tpl-portlet-components">
        <div class="portlet-title">
            <div class="caption font-green bold">
                <span class="am-icon-code"></span> 表单
            </div>
            <div class="tpl-portlet-input tpl-fz-ml">
                <div class="portlet-input input-small input-inline">
                    <div class="input-icon right">
                        <i class="am-icon-search"></i>
                        <input type="text" class="form-control form-control-solid" placeholder="搜索..."> </div>
                </div>
            </div>
        </div>
        <div class="tpl-block ">

            <div class="am-g tpl-amazeui-form">

                <div class="am-u-sm-12 am-u-md-9">

                    <form class="am-form am-form-horizontal"  method="post" action="{:url('report/ReportInfoPost')}">
                        <div class="am-form-group am-form-success am-form-icon am-form-feedback">
                            <label for="doc-ipt-3-a" class="am-u-sm-2 am-form-label">千麦条码： / ID</label>
                            <div class="am-u-sm-10">
                                <input type="text" id="doc-ipt-3-a"  name="ybid" class="am-form-field" placeholder="输入千麦条码" value="{$res.ybid|default=''}">
                                <span class="am-icon-warning"></span>
                            </div>
                        </div>
                        <div class="am-form-group">
                            <div class="am-u-sm-9 am-u-sm-push-6">
                                <button type="submit" class="am-btn am-btn-primary">点击删除</button>

                            </div>
                        </div>
                    </form>

                    <form class="am-form am-form-horizontal"  method="post" action="{:url('report/ReportInfoPost')}">
                        <div class="am-form-group am-form-success am-form-icon am-form-feedback">
                            <label for="doc-ipt-3-a" class="am-u-sm-2 am-form-label">千麦条码： / ID</label>
                            <div class="am-u-sm-10" >
                                <input type="text" id="doc-ipt-3-a"  name="ybid" class="am-form-field" placeholder="输入千麦条码" value="{$res.ybid|default=''}">
                                <span class="am-icon-warning"></span>
                            </div>
                            <div class="am-scrollable-vertical ">

                            </div>
                        </div>
                        <div class="am-form-group">
                            <div class="am-u-sm-9 am-u-sm-push-6">
                                <button type="submit" class="am-btn am-btn-primary">点击查询</button>

                            </div>
                        </div>
                    </form>
                    <!--<div class="am-g" style="margin-left: 17%">
                        <div class="am-u-md-8 am-u-sm-centered" >
                            <form class="am-form" method="post" action="{:url('report/ModifyID')}">
                                <fieldset class="am-form-set">
                                    <input type="text" placeholder="千麦条码" name="ybid" value="{$res.ybid|default=''}">
                                    <input type="text" placeholder="身份证" name="idnumber" value="{$res.idnumber|default=''}">
                                    &lt;!&ndash;<input type="email" placeholder="登录密码" name="password" value="{$data.password|default=''}">&ndash;&gt;
                                    &lt;!&ndash;         <input type="text" placeholder="是否配置报告章&#45;&#45;'是' or '否'">
                                           &lt;!&ndash;  <select multiple data-am-selected  >
                                                 <option value="a">Apple</option>
                                                 <option value="b" selected>Banana</option>

                                             </select>&ndash;&gt;
                                             <input type="text" placeholder="业务员">
                                             <input type="text" placeholder="业务经理">
                                             <input type="email" placeholder="报告抬头">&ndash;&gt;
                                </fieldset>
                                <button type="submit"  class="am-btn am-btn-primary am-btn-block">确认修改并重新生成报告</button>
                            </form>
                        </div>
                    </div>-->
                </div>
            </div>
        </div>
    </div>
</div>

</div>

</div>
</div>
{include file="public/footer"/}
</body>
</html>
